Dietary diversity and its determinants among women of reproductive age residing in the urban area of Nouakchott, Mauritania

BACKGROUND

The intake of nutrient-rich foods from diverse diets ensures adequate nutrition for women. This study aims to determine dietary diversity among women of reproductive age (WRA) using the MDD-W indicator and how it relates to their socio-economic characteristics in the city of Nouakchott, Mauritania.

METHODS

A community-based cross-sectional study was conducted on 240 women of reproductive age, aged 15-49 years. Food consumption data were obtained through unquantified 24 h recall which is designed to identify all foods consumed by the women during this period. We computed MDD-W as the consumption of at least five out of ten predefined food groups according to the guideline of the Food and Agriculture Organization (FAO) of the United Nations. In order to determine which factors had a statistically significant influence on dietary diversity among women, we used a value of P < 0.05.

RESULTS

The mean of dietary diversity was 5.48 and 71.7% of WRA had an acceptable minimum dietary diversity. During the study period, 96.25% and 80% of women consumed vitamin A and iron-rich foods respectively. The consumption rate of starchy foods, vitamin A-rich fruits and vegetables, meat, fish and chicken, milk and dairy products, dark green leafy vegetables and finally other vegetables was higher; 99.6%, 75.3%, 80%, 62.5%, 60.4% and 83.3% respectively. On the other hand, the consumption of legumes, eggs and other fruits was low; at 21.7%, 14.2% and 13.8% respectively.

CONCLUSIONS

The study showed that more than half of the studied population had an acceptable minimum dietary diversity. The diet was mainly based on the consumption of starchy foods, meat and other vegetables than those rich in vitamin A.

Nutritional awareness of pregnant women and the underlying influencing factors

Nutritional awareness is described as having knowledge or understanding of nutrition. It is often related to the ability of an individual to make an accurate estimate of their food intake, which involves comparing their actual nutritional behavior with the recommended food consumption. Nutritional awareness of women during the various phases of pregnancy may vary significantly across countries due to cultural and lifestyle differences. There has been extensive research on nutritional awareness of pregnant women in selected countries or regions; however, relatively few studies have explored it during different stages of pregnancy. To fill this gap, this article reviews the existing literature and draws together insights into the following areas: changes in nutritional awareness during various phases of pregnancy, nutritional awareness of pregnant women and its underlying factors in various nations, and the research methods used to study nutritional awareness of pregnant women.

The misbeliefs and food taboos during pregnancy and early infancy: a pitfall to attaining adequate maternal and child nutrition outcomes among the rural Acholi communities in Northern Uganda

BACKGROUND

In developing countries, the practice of food taboo is pervasive. The types of foods considered as taboos and the reasons attached to taboos vary from society to society. Food taboos have been recognized as one of the factors contributing to maternal undernutrition in pregnancy, especially in rural settings. In the rural Acholi community where malnutrition is prevalent, very little is known about these food taboos and misbeliefs. This study, therefore, aims to explore various misbeliefs and food taboos in the time of pregnancy that can influence maternal and child nutrition outcomes in Acholi.

METHODS

A community-based qualitative cross-sectional study was conducted between April and May 2022 in five districts in the Acholi subregion. Focus group discussions (FGDs) and key informant interviews (KIIs) were used to collect data. Data transcription was done verbatim, organised into themes, assigned unique color codes, and manually analysed thematically.

RESULTS

Upon scrutiny of the transcripts, three themes were eminent. The first theme focused on foods that are considered taboos in Acholi community and the reasons linked to them. Participants indicated offals, chicken, wild birds, smoked meat and fish, sugarcane, garden egg ('Tula'), groundnut, bush meat, mushrooms, honey, sour fruits, or meals (oranges, mango, passion fruits, lemon, tamarind, 'Malakwang'), goat's meat, 'Lalaa' (the bitter green leafy vegetable), and 'Lamola' (Hyptis spicigera) as the major taboo foods. The second theme was the reasons underlying the adherence to the food taboos and misconceptions. Cultural dictates, individual characteristics, and societal context were the main reasons for the adherence to food taboos. The third theme looked at the misconceptions and other taboos during pregnancy. It was found that pregnant women are not allowed to touch grave soil, shave their hair, walk over an anthill, slaughter chicken or birds, have sex during pregnancy, sit on animal's hide or skin, and/or touch needles.

CONCLUSIONS

Nutritional counseling and education should focus more on addressing food taboos. The mode of delivery of the nutrition message should be inclusive, targeting pregnant women and their spouses, school-going children, adolescent girls, and cultural leaders at their respective points of contact.

Dietary patterns in relation with nutritional outcomes and associated factors among adolescents: implications for context-specific dietary intervention for the Agrarian Community, Northwest Ethiopia

Introduction

Dietary pattern analysis allows us to characterize the dietary intakes of individuals rather than nutrient intake data and strongly predicts disease risks. The relationship between food intake and adolescents' nutritional health is not well understood yet. Therefore, this study aimed to generate evidence for context-specific dietary intervention for adolescents.

Objective

This study aimed to determine dietary patterns and their relationship with nutritional outcomes and identify the contributing factors among adolescents in the Agrarian Community of Northwest Ethiopia.

Methods

A cross-sectional survey was conducted among 622 randomly selected adolescents. Dietary data were collected over a 1-week recall period using the Food Frequency Questionnaire (FFQ). After testing the basic assumptions, an exploratory factor analysis was conducted to determine the dietary patterns. Anthropometric data on weight and height were collected to determine the nutritional status using WHO Anthroplus 2010 software. A chi-square test was conducted to evaluate the effect of different dietary patterns on nutritional outcomes. A multivariable binary logistic regression model was used to identify factors affecting the dietary patterns of adolescents.

Result

Three types of dietary patterns, namely, traditional, mixed, and animal-source foods with traditional alcoholic beverage consumption were identified. These dietary patterns explain 58.64% of the variance in adolescent diet in the study setting. The burden of stunting was 15.12% vs. 11.21, 19.40% vs. 6.94, and 8.36% vs.17.97% among adolescents with lower traditional, mixed, and higher animal sources with alcoholic dietary pattern consumption habits, respectively (value of p <0.05). Adolescents who resided in low-land agroecology (AOR = 2.44; 95% CL: 1.24, 4.81) and had access to animal-source foods (AOR = 1.64; 95% CI: 1.04, 2.60) were associated with lower consumption of traditional dietary patterns. Similarly, adolescents who resided in low-land (AOR = 1.80; 95% CI: 1.18, 2.74) had formal education (AOR = 2.38; 95% CI: 1.35, 4.19) and had poor nutrition knowledge (AOR = 2.83; 95% CL: 1.55, 5.19) were associated with lower consumption of mixed dietary patterns. Moreover, adolescents residing in the high-land (AOR = 2.50; 95% CI: 1.37, 4.56) and being female (AOR =1.87; 95% CI: 1.27, 2.74) were significant factors associated with lower consumption of animal-sourced foods with traditional alcoholic beverage consumption patterns.

Conclusion

Multidimensional modifiable factors were explored that could be targeted for public health interventions for the identified dietary patterns. Integrated and multifaceted dietary intervention approaches are needed to promote healthy diets and discourage the consumption of unhealthy diets to reduce undernutrition in the study area and similar settings.

Understanding the traditional values and use of okra among pregnant women in western Ethiopia: a qualitative study

OBJECTIVES

This study explored the traditional values and use of okra among pregnant women, how okra plants are obtained, prepared and used by pregnant women, and the associated beliefs and meanings attached to it in western Ethiopia.

DESIGN

Qualitative research.

SETTING

Rural areas of western Ethiopia.

PARTICIPANTS

A purposive sampling technique was used to select a total of 86 pregnant women (14 for in-depth interviews and 72 for focus group discussions) in western Ethiopia.

RESULTS

Traditionally okra is used as a source of income and is a common food for guests visiting homes. In line with this, pregnant women in the western part of Ethiopia mainly consumed okra pods. For future consumption and preservation for a long period, they usually transform okra into powder.

CONCLUSIONS

Other parts of the okra plant rather than pods are not known as a food source and are the most neglected food sources in rural districts of western Ethiopia. The study provides evidence that supports nutritional behavioural change communication interventions on promoting the utilisation of different parts of okra and awareness creation on the nutritional values of okra.

Food taboo practices and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

Food taboos have a negative impact on pregnant women and their fetuses by preventing them from consuming vital foods. Previous research found that pregnant women avoided certain foods during their pregnancy for a variety of reasons. This review aimed to determine the pooled prevalence of food taboo practices and associated factors in Ethiopia. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, we searched the literature using PubMed/MEDLINE, AJOL (African Journal Online), HINARI, Science Direct, Google Scholar, and Google electronic databases. The random-effects model was used to estimate the pooled prevalence of food taboo and its determinants at a 95% confidence interval with their respective odds ratios. The pooled food taboo practice among Ethiopian pregnant women was 34.22% (95% CI 25.47-42.96), and after adjustment for publication bias with the trim-and-fill analysis, the pooled food taboo practice of pregnant women was changed to 21.31% (95% CI: 10.85-31.67%). Having less than a secondary education level (OR = 3.57; 95% CI 1.43-8.89), having no ANC follow-up (OR = 4.35; 95% CI 1.12-16.94), and being a rural resident (OR = 3.08; 95% CI 1.14-8.28) were the significant factors. Dairy products, some fruits, green leafy vegetables, meat, and honey are among the taboo foods. The most frequently stated reasons for this taboo practice were: fear of producing a big fetus, which is difficult during delivery; attachment to the fetus's body or head; and fear of fetal abnormality.

Prevalence of undernutrition among pregnant women and its differences across relevant subgroups in rural Ethiopia: a community-based cross-sectional study

BACKGROUND

Maternal undernutrition is one of the commonest public health problems in many low- and middle-income countries where generally more than 20% of women are undernourished. It is more common in rural areas due to unclear factors. Therefore, the aim of this study was to investigate the prevalence of undernutrition in general and in subgroups and determine risk factors among pregnant women in rural Ethiopia.

METHODS

A community-based cross-sectional survey was conducted from April 30 to May 30, 2019 on 550 pregnant women who were randomly selected from six districts in southern Ethiopia. Trained and experienced nurses measured undernutrition using mid-upper arm circumference and collected other data. We used multilevel mixed-effect logistic regression to identify factors associated with undernutrition among pregnant women.

RESULTS

The prevalence of undernutrition among pregnant women was 38% (95% CI: (34.2-42.3). The odds of undernutrition was higher among women who got pregnant previously (adjusted odds ratio [AOR]: 1.66; 95% CI: 1.02-2.71), who had a history of miscarriage (AOR: 3.18; 95% CI: 1.77-5.70), who practiced food taboos (AOR: 2.23; 95% CI: 1.47-3.39), and who did not get any nutritional counseling during pregnancy (AOR: 2.97; 95% CI: 1.79- 4.95). The prevalence of undernutrition was higher among pregnant women who had multiple risk factors and the difference was statistically significant (p < 0.001).

CONCLUSION

Undernutrition is a highly prevalent problem among rural Ethiopian pregnant women, especially with those who avoid food, do not get counseled, and had two or more pregnancies and a history of miscarriage. Improving the integration of nutrition programs with routine healthcare services and encouraging a multi-sectorial intervention strategy would help to reduce maternal undernutrition in the country.

Exploring barriers to diversified dietary feeding habits among adolescents in the agrarian community, North West Ethiopia

Introduction

Adolescence is a critical and neglected age group of the population in any form of nutritional intervention. A comprehensive study that assesses barriers that influence their diversified feeding habit is not well investigated in qualitative approaches. Therefore, this study was conducted to fill this gap by providing evidence on exploring barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia.

Objective

The aim of the study was to explore barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia.

Methods

A phenomenological qualitative study design was conducted among adolescents in the age group of 10-19 years, and adults in the age range of 25 to 64 years (representatives of farmers, agricultural, health, and education sectors). We conducted 24 in-depth interviews (12- adolescents, 4-health, 2- agricultural extension, 3-education, and 3-farmer representative) among purposively selected community groups. In-depth interview guides and observation checklist were utilized for data collection. The audio-recorded qualitative data were transcribed word by word into English. Finally, the translated data were exported to ATLAS ti version 7.1 software for thematic analysis based on inductive content analysis. All coded quotations, including memos written throughout the coding process, were then analyzed to identify themes inductively.

Results

Dietary habit of adolescents in the study area was predominantly plant-based cereals with low protein, vitamins, and mineral contents. Adolescents have limited consumption of fruits, vegetables, and animal source foods. Adolescents with these feeding habits had suboptimal intake of micronutrients and proteins, which are crucial for their rapid growth stage. Individual-level barriers, family-level influence, dietary tradition of community, agricultural practice (poor agroforestry practice of the community, and poor agricultural practice to produce year-round diverse food items), and week multi-sectorial collaboration for nutritional intervention all influenced adolescent dietary habits.

Conclusion

Multiple layers of barriers influenced the diverse dietary habits of adolescents in the study setting. These multiple and interconnected influences ranged from individual level to multi-sectorial collaboration. Nutritional interventions should be implemented at the individual, family, agricultural, and multi-sectorial levels to improve adolescents' diverse dietary habits.

Determinants of coexistence of stunting, wasting, and underweight among children under five years in the Gambia; evidence from 2019/20 Gambian demographic health survey: application of multivariate binary logistic regression model

Background

Malnutrition happens when there are insufficient amounts of nutrients and energy consumed improperly. Included are both undernutrition and overnutrition. This study is aimed to evaluate the relationship among undernutrition indicators of stunting, underweight, and wasting among those under 5 years given other predictors.

Methods

The data were obtained from the measure of DHS program. A total of 2399 under-five children were involved in this study. A multivariate binary logistic regression model is used to assess the association between stunting, wasting, and being underweight given the effect of other predictors.

Results

Of the 2399 under-five children considered in this study, 13.5, 18.7, and 5.9% of them suffered from stunting, underweight, and wasting, respectively. The majority of children (40.1%) were obtained from the Brikama local government area of Gambia; more than half of the children (52.9%) were male, and 63.3% of children lived in urban areas. The association between stunting and underweight, underweight and wasting, and stunting and wasting was measured by the odds ratio (OR) of 15.87, 46.34, and 1.75, respectively, given the other predictors. The estimated odds ratio for children who had an average birth size to become stunted, underweight, and wasted were 0.965, 0.885, and 0.989 times the estimated odds ratio of children who had a small birth size, respectively.

Conclusion

The prevalence of stunting and wasting for under-five children in Gambia was lower than the world prevalence, but the prevalence of being underweight was higher. Children who are underweight have a significant association with both stunting and wasting. The age of the child, the child’s anemia level, and the birth type of the child are the common important determinants of stunting and underweight. The small birth size of a child was highly associated with a higher risk of stunting, underweight, and wasting among under five-year-olds.

Socio-cultural beliefs influence feeding practices of mothers and their children in Grand Popo, Benin

BACKGROUND

Malnutrition is a major public health problem. It contributes to the high death rate among children in developing countries despite the various advocacies of institutions such as WHO and FAO and many other organisations. More research needs to be done in order to contribute to the achievement of the Sustainable Development Goals. The aim of this study was to explore socio-cultural practices and their influence on feeding practices of mothers and their children in Grand Popo, Benin.

METHODS

A qualitative research methodology was used with an inductive approach. A pretested discussion guide was used to conduct focus group discussions with participants in their local language. Four focus group discussions were held in 4 villages located in both the rural and the semi-urban areas with each focus group comprising seven to eight participants. The study protocol was approved by the Health Research Ethics Committee of Stellenbosch University. Focus group discussions were recorded, transcribed and translated to English. The data was analysed following the Creswell data analysis steps.

RESULTS

All the children were breastfed, and 56.1% of children under 6 months received breast milk exclusively. Children were introduced to family foods at 5 months with very low consumption of animal protein and fruits. Mothers and children had monotonous diets with high consumption of vegetables and maize-based meals. Food taboos, particularly during pregnancy, were revealed. Those cultural beliefs were still followed by some mothers, and food rich in nutrients were pushed aside.

CONCLUSIONS

There is a need for educational interventions to raise awareness of the negative impacts of some socio-cultural practices on the health of the mother and child.

Food Taboos and Cultural Beliefs Influence Food Choice and Dietary Preferences among Pregnant Women in the Eastern Cape, South Africa

A well-nourished and healthy population is a central tenet of sustainable development. In South Africa, cultural beliefs and food taboos followed by some pregnant women influence their food consumption, which impacts the health of mothers and children during pregnancy and immediately afterwards. We documented food taboos and beliefs amongst pregnant isiXhosa women from five communities in the Kat River Valley, South Africa. A mixed-methods approach was used, which was comprised of questionnaire interviews with 224 women and nine focus group discussions with 94 participants. Overall, 37% of the women reported one or more food practices shaped by local cultural taboos or beliefs. The most commonly avoided foods were meat products, fish, potatoes, fruits, beans, eggs, butternut and pumpkin, which are rich in essential micronutrients, protein and carbohydrates. Most foods were avoided for reasons associated with pregnancy outcome, labour and to avoid an undesirable body form for the baby. Some pregnant women consumed herbal decoctions for strengthening pregnancy, facilitating labour and overall health of both themselves and the foetus. Most learnt of the taboos and practices from their own mother or grandmother, but there was also knowledge transmission in social groups. Some pregnant women in the study may be considered nutritionally vulnerable due to the likelihood of decreased intake of nutrient-rich foods resulting from cultural beliefs and food taboos against some nutritious foods. Encouraging such women to adopt a healthy diet with more protein-rich foods, vegetables and fruits would significantly improve maternal nutrition and children's nutrition. Adhering to culturally appropriate nutrition education may be an important care practice for many pregnant women in the Kat River Valley.

Is chronic malnutrition associated with an increase in malaria incidence? A cohort study in children aged under 5 years in rural Gambia

Background

Malnutrition is common in children in sub-Saharan Africa and is thought to increase the risk of infectious diseases, including malaria. The relationship between malnutrition and malaria was examined in a cohort of 6–59 month-old children in rural Gambia, in an area of seasonal malaria transmission. The study used data from a clinical trial in which a cohort of children was established and followed for clinical malaria during the 2011 transmission season. A cross-sectional survey to determine the prevalence of malaria and anaemia, and measure the height and weight of these children was carried out at the beginning and end of the transmission season. Standard anthropometric indices (stunting, wasting and underweight) were calculated using z-scores.

Results

At the beginning of the transmission season, 31.7% of children were stunted, 10.8% wasted and 24.8% underweight. Stunting was more common in Fula children than other ethnicities and in children from traditionally constructed houses compared to more modern houses. Stunted children and underweight children were significantly more likely to have mild or moderate anaemia. During the transmission season, 13.7% of children had at least one episode of clinical malaria. There was no association between stunting and malaria incidence (odds ratio = 0.79, 95% CI: 0.60–1.05). Malaria was not associated with differences in weight or height gain.

Conclusions

Chronic malnutrition remains a problem in rural Gambia, particularly among the poor and Fula ethnic group, but it was not associated with an increased risk of malaria.

Trial registration

Trial registration: ISRCTN, ISRCTN01738840, registered: 27/08/2010 (Retrospectively registered).

Food beliefs and practices among the Kalenjin pregnant women in rural Uasin Gishu County, Kenya

BACKGROUND

Understanding food beliefs and practices is critical to the development of dietary recommendations, nutritional programmes, and educational messages. This study aimed to understand the pregnancy food beliefs and practices and the underlying reasons for these among the contemporary rural Kalenjin communities of Uasin Gishu County, Kenya.

METHODS

Through semi-structured interviews, data was collected from 154 pregnant and post-natal Kalenjin women about restricted and recommended foods, and why they are restricted or recommended during pregnancy. Respondents were purposively selected (based on diversity) from those attending Maternal and Child Health (MCH) care in 23 rural public health facilities. Key informant interviews (n = 9) with traditional Birth Attendants (TBA) who were also herbalists, community health workers, and nursing officers in charge of MCH were also conducted. Quantitative data was analysed using SPSS software. Data from respondents who gave consent to be tape recorded (n = 42) was transcribed and qualitatively analysed using MAXQDA software.

RESULTS

The restriction of animal organs specifically the tongue, heart, udder and male reproductive organs, meat and eggs, and the recommendation of traditional green vegetables and milk was reported by more than 60% of the respondents. Recommendation of fruits, traditional herbs, ugali (a dish made of maize flour, millet flour, or Sorghum flour, sometimes mixed with cassava flour), porridge and liver, and restriction of avocadoes and oily food were reported by more than 20% of the respondents. The reasons for observing these dietary precautions were mainly fears of: big foetuses, less blood, lack of strength during birth, miscarriages or stillbirths, and maternal deaths as well as child's colic and poor skin conditions after birth.

CONCLUSION

Pregnancy food beliefs were widely known and practised mainly to protect the health of the mother and child, and ensuring successful pregnancy outcome. Given the deep-rooted nature of the beliefs, it is advisable that when nutritious foods are restricted, nutritional interventions should rather search for alternative sources of nutrition which are available and considered to be appropriate for pregnancy. On the other hand, nutritional advice that does not address these health concerns and assumptions that underlie successful pregnancy and delivery is unlikely to be effective.

Foods tabooed for pregnant women in Abala district of Afar region, Ethiopia: an inductive qualitative study

Background

Food taboo is contributing substantially to malnutrition for pregnant women by restricting and limiting the frequency and variety of foods most of which are nutritious and easily accessible. The practice is common in developing countries and most of the food taboos in East Africa fall on the women and most unfortunately on the pregnant. Foods of animal products, which are the main sources dietary energy of pastoralist communities, are often prone to the practice of food taboos. Nonetheless, the existence of the practice in Ethiopian pastoralist communities, the communities whose way of life is mostly nomadic and based on tending of herds or flocks, is not investigated yet. Therefore, the current study aimed to explore foods tabooed for pregnant women and the reasons behind the practice if exists in Abala district of Afar region, Ethiopia.

Methods

Exploratory qualitative study was conducted inductively involving homogeneous participants in four focus group discussions and eight key informants in individual in-depth interview who were purposively selected in Aballa district from March 1 to 30, 2016. A semi-structured interview guide was used to collect the data. The investigators audiotaped focus group discussions and interviews and then transcribed them verbatim. Finally, the transcribed data were imported to Atlas.ti 7 software for coding. Analysis was done inductively. Triangulation and peer debriefing were applied to assure data quality.

Results

The study revealed that foods tabooed for pregnant women were 1) Eating a large amount of food of any type, 2) fatty foods like meat, milk and yoghurt, 3) Foods that are not in liquid form such as different types of bread and 4) cool/cold foods such as cold milk, cold meat and cold water. The reasons mentioned to adhere with the foods taboo for pregnant women were to avoid difficulty to deliver the fetus, to prevent disease like Gastritis, Diarrhea, Typhoid and skin discoloration of the fetus. Besides, inconveniences like abdominal cramp were reported as reasons to adhere the foods tabooed.

Conclusions

Pregnant women in Aballa district avoid eating numerous accessible foods because the foods are believed as tabooed for them. Further studies that focus on the extent of food taboo and uncovering the understanding on how it is being practiced were recommended.

Food taboos and myths in South Eastern Nigeria: The belief and practice of mothers in the region

BACKGROUND

Poor nutritional practices especially in pregnancy and early childhood can result in dire consequences in the growth and development of a child.

METHODS

This study using purposive sampling enrolled 149 women who had carried at least one pregnancy to term in Enugu south east Nigeria. Logistic regression analysis was used to assess association between avoidance of certain food in pregnancy and selected socio-demographic factors.

RESULTS

Approximately 37 % of respondents avoided some foods in pregnancy due to food taboos and no relationship was seen between this avoidance of food and maternal educational attainment, parity (number of obstetrics deliveries) and occupation. Snail and grass-cutter meat were the commonly avoided food in pregnancy while egg were commonly avoided in children under-two years old. Some respondent believed eating snail and grass-cutter meat makes a child sluggish and labour difficult respectively while starting egg early for a child could predispose them to stealing later in life.

CONCLUSION

Discussion about food taboos during antenatal care visits and during community education can help reduce the traditional belief about certain food in pregnancy and early childhood.